Provider Demographics
NPI:1730339771
Name:NARCONON OF OKLAHOMA, INC
Entity type:Organization
Organization Name:NARCONON OF OKLAHOMA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOOTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-587-7771
Mailing Address - Street 1:HC 67 BOX 5
Mailing Address - Street 2:
Mailing Address - City:CANADIAN
Mailing Address - State:OK
Mailing Address - Zip Code:74425-9700
Mailing Address - Country:US
Mailing Address - Phone:954-587-7771
Mailing Address - Fax:954-587-8622
Practice Address - Street 1:HC 67 BOX 5
Practice Address - Street 2:
Practice Address - City:CANADIAN
Practice Address - State:OK
Practice Address - Zip Code:74425-9700
Practice Address - Country:US
Practice Address - Phone:954-587-7771
Practice Address - Fax:954-587-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility